Implementation and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): perceptions of health decision-makers and health-care providers

Abstract

Background The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up. Methods A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women’s needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy’s sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests. Conclusion Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.

Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: Knowledge and perceptions of health providers from Argentina

“…A study that analyzed stakeholders' acceptability of an mHealth intervention to increase adherence to triage among HPV-positive women found that the intervention being proposed by prestigious external institutions and then designed and implemented collaboratively through consensus with local institutions and health providers was a perceived as facilitator. 27 In our study, respondents also pointed out they perceived WHO recommendations as too general and not for speci c local contexts. When knowledge can be codi ed and transferred across contexts, implementation is more likely to be successful.…”

Agentes Sanitarios y mSalud: Adopción de estrategias para la prevención del cáncer cervicouterino en Argentina

“…Si bien se observa una mayor intención de adopción entre los AS del grupo intervención, en ambos grupos la intención de adopción supera el 70 %, lo que muestra buena percepción acerca de la estrategia. Este resultado complementa lo reportado en las evaluaciones post-implementación realizadas entre los profesionales de la salud, decisores y mujeres participantes, (16,22) mostrando que la estrategia, no solo es efectiva, si no también que posee alta aceptabilidad y adopción para ser implementada en el futuro.…”

“…Las ventajas percibidas coinciden con lo reportado por los profesionales de la salud y decisores. (22) Esta coincidencia es clave, dado que el reconocimiento de la ventaja relativa de una innovación por parte de todos los actores involucrados es condición sine qua non para la futura implementación. (26) Por ejemplo, un estudio realizado en Canadá mostró que el principal factor facilitador de la adopción de una estrategia de mSalud para el monitoreo de pacientes con patologías cardiovasculares fue la percepción de los implementadores de que tenía múltiples ventajas por sobre otros sistemas de telemedicina.…”

“…Asimismo, consideraron que la información debía ser enviada a personal de salud con mayor grado de responsabilidad y poder para asegurar el efectivo acceso al triaje. (22) Esta adaptación es clave para contribuir a la mejora de la red de referencia y contrarreferencia, muchas veces el principal factor obstaculizador del acceso a diagnóstico-seguimiento, y así lograr la reducción de la incidencia y mortalidad por CC.…”

“…(18,21) Cabe destacar que, en publicaciones previas se reportaron resultados acerca del alcance, la eficacia, la implementación y el mantenimiento de la estrategia ATICA (conceptos del RE-AIM), así como sobre factores que condicionan la implementación desde la perspectiva de decisores y profesionales de la salud. (16,22) En el presente estudio se exponen resultados sobre la intención de adoptar dicha estrategia desde la perspectiva de los/las AS en tanto implementadores. (16) Asimismo, el contexto en el que se implementa una innovación es un conjunto dinámico y diverso de fuerzas que trabajan a favor o en contra de los esfuerzos de implementación (factores que facilitan u obstaculizan).…”